Search

Background: The impact of removing the upper airway lymphoid tissue and in particular, tonsillectomy, in adults with OSA has not been demonstrated in large populations. Aims: To compare the severity of OSA and the prevalence of cardiovascular, metabolic and respiratory co-morbidities between patients with OSA who had undergone previous tonsillectomy and those who had not. Methods: The 19,711 participants in this study came from the European sleep apnea database (ESADA) which comprises data from unselected adult patients aged 18–80 years with a history of symptoms suggestive of OSA referred to sleep centers throughout Europe. Results: There were no differences between the two groups in terms of sex ratio and age (146 patients with previous tonsillectomy vs. 19565 patients without). Patients who had undergone tonsillectomy had a lower body mass index (29.3 ± 5.2 kg/m2 vs 32.2 ± 6.6 kg/m2, p < 0.001), lower subjective sleep latency (17.1 ± 17.8 min vs 25.5 ± 30.4 min, p = 0.001), lower ODI (15.7 ± 18.3 events/hour vs 30.7 ± 26.1 events/hour, p < 0.001), and SpO2, European Respiratory Society, ERS, The ESADA network has previously received support from the European Union COST action B26 and the European Respiratory Society. We gratefully acknowledge unrestricted seeding grants from ResMed Inc and Philips Respironics Inc. for establishment of the organisation and the database. Excellent technical assistance in terms of centre monitoring and database maintenance was provided by Ann-Christin Lundquist, RN and Jeanette Norum, RN.

Obstructive sleep apnoea (OSA) is considered as a risk factor for the development of arterial hypertension, coronary artery disease (CAD), myocardial infarction and stroke. These clinical manifestations are the consequences of elevated sympathetic activity, cardiovascular variability, intrathoracic pressure changes, inflammation, oxidative stress, endothelial dysfunction, insulin resistance and thrombosis provoked by OSA. As a result, OSA is often present in patients with cardiovascular disease (CVD) and the increased prevalence of CVD in OSA population raises both cardiovascular morbidity and mortality and the demand of healthcare resources. Observational cohort studies indicate that untreated patients with OSA have an increased risk of fatal and non-fatal cardiovascular events, an increased risk of sudden cardiac death during the sleeping hours and a higher risk of stroke or death from any cause. Continuous positive airway pressure (CPAP) and oral appliance therapy are the two treatments for OSA whose effects on cardiovascular endpoints have been assessed in randomised trials. There is increasing evidence that adequate CPAP therapy leads to a significant reduction in cardiovascular morbidity.

The European Sleep Apnoea Database (ESADA) reflects a network of 22 sleep disorder centres in Europe enabled by a COST action B26 programme. This ongoing project aims to describe differences in standard clinical care of patients with obstructive sleep apnoea (OSA) and to establish a resource for genetic research in this disorder. Patients with suspected OSA are consecutively included and followed up according to local clinical standards. Anthropometrics, medical history, medication, daytime symptoms and sleep data (polysomnography or cardiorespiratory polygraphy) are recorded in a structured web-based report form. 5,103 patients (1,426 females, mean±SD age 51.8±12.6 yrs, 79.4% with apnoea/hypopnoea index (AHI) ≥5 events·h -1) were included from March 15, 2007 to August 1, 2009. Morbid obesity (body mass index ≥35 kg·m -2) was present in 21.1% of males and 28.6% of females. Cardiovascular, metabolic and pulmonary comorbidities were frequent (49.1%, 32.9% and 14.2%, respectively). Patients investigated with a polygraphic method had a lower AHI than those undergoing polysomnography (23.2±23.5 versus 29.1±26.3 events·h -1, p

Le centre pluridisciplinaire des troubles du sommeil dAnvers a débuté ses activités en 1982 et a développé divers axes de recherche dans le domaine des troubles respiratoires liés au sommeil. Le premier projet de thèse à y être réalisé avait pour thème : « Mécanismes de linstabilité respiratoire durant le sommeil chez ladulte » et étudiait le contrôle des mécanismes respiratoires impliqués dans lapnée du sommeil. Cela a conduit les équipes du centre vers un intérêt pour la physiopathologie de lapnée du sommeil, les mesures de pression pharyngo-sophagiennes et la mesure de la pression critique docclusion des voies aériennes supérieures. De nouvelles modalités thérapeutiques y ont été développées, notamment limplantation du premier pacemaker du nerf hypoglosse. Le centre a également participé à de nombreuses études multicentriques axées sur les effets de nouvelles techniques prometteuses telles la réduction des tissus pharyngés par radiofréquence pour le ronflement et lapnée, lexpansion de los hyoïde, limplant lingual adaptable, ainsi que les prothèses davancement mandibulaire personnalisées. De nouvelles techniques diagnostiques, comme la technique des oscillations forcées et la dynamique des fluides, y ont été introduites et ont permis daccroître nos connaissances physiopathologiques et thérapeutiques. Plus récemment, la recherche sest développée dans le domaine de lapnée du sommeil chez lenfant et les mécanismes reliant le trouble respiratoire lié au sommeil et le syndrome métabolique chez lenfant obèse. Un certain nombre de ces travaux ont été publié dans des revues scientifiques à comité de lecture et ont certainement contribué au prestige de la médecine du sommeil (dans ses aspects respiratoires) belge au sein de la communauté européenne. The Multidisciplinary Sleep Disorders Centre of the Antwerp University Hospital started its activities in 1982 and developed various research lines in the field of sleep disordered breathing. The first PhD project focused on Mechanisms of unstable breathing during sleep in adults and studied the control of breathing mechanisms involved in sleep apnea. This led to more interest in the physiopathology of sleep apnea, which was further elaborated based on pharyngoesophageal pressure measurements to determine the site of collapse, and measurement of the critical closing pressure (Pcrit). The new insights were applied in the development of new treatment modalities, which lead to the implantation of the first hypoglossal nerve pacemaker. The centre also participated in multicentric trials looking at the efficacy of promising techniques, like radiofrequency ablation technique for snoring and sleep apnea, the hyoid expansion technique (titanium implant), the titratable tongue anchor implant technique (Advance®), and boile and bite as well as custom made mandibular advancement devices. New diagnostic techniques, like forced oscillation technique and computational fluid dynamics, have been introduced in the field and have enlarged our insight in physiopathology and in outcome of therapeutic interventions. More recently, research was developed in pediatric sleep apnea, investigating the mechanisms underlying the link between sleep-disordered breathing and the metabolic syndrome in obese children. Many studies have been published in peer-reviewed journals and this has certainly improved the prestige of the Belgian (respiratory) sleep medicine in Europe.